One thing that happens is that the prices increase for services at these clinics. According to hospitals, one reason is that because hospitals (unlike individual doctors) must maintain 24-hour emergency room coverage and cannot turn away patients, they need to raise revenue elsewhere to help absorb this expense. Thus hospitals charge higher rates for many items than do private practices. Nationally, hospitals are buying more and more clinics, where they are also charging higher rates.
As the Affordable Care Act attempts to steer people away from pricey inpatient admissions, hospitals have begun buying up doctors’ offices in hopes of increasing their revenue and market share. The number of oncology practices owned by hospitals, for instance, increased by 24 percent from 2011 to 2012.
Cancer drugs often double in price when hospital systems charge for them. A treatment of Herceptin, a breast cancer drug, costs private insurers $2,740 when used in an independent clinic and $5,350 in a hospital outpatient setting, according to an analysis of 2012 claims by PricewaterhouseCoopers’ Health Research Institute. The price of Avastin increased from $6,620 to $14,100 when used in a hospital setting, the Health Research Institute says.
In some instances conflicts have arisen between insurance companies and hospitals over how much to pay for treatment. In one case, the insurer says reverting to lower payments for roughly 20,000 Pennsylvania chemotherapy patients should $200 million a year.
Steven Weiss, spokesman for the American Cancer Society’s Cancer Action Network, said in an e-mail. “For years, patients have paid different prices for the same procedure or drug, depending on where they are treated,” he said, and “long-standing trends like this one continue to threaten patient access to lifesaving care.” Read more…